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35-187
. ACQ-�M CERTIFICATE OF LIABILITY INSURANCE olio j2 3) PRODUCER! (413)527-5520 FAX (413)S27-S970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Finck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6 Campus Lane HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 Rebecca Kubosiak INSURERS AFFORDING COVERAGE NAIC# INSURED Nelson Roberts INSURERA: National Grange Mutual Ins. Co 14788 P.O. BOX 203 INSURER B: Easthampton, MA 01027 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTW ITHSTANDINI ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY MP384792 06/04/2003 06/04/2004 EACH OCCURRENCE $ 300,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ S00,000 CLAIMS MADE �OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 600,000 POLICY PRO JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STIMIT OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Northampton 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building Dept. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY City Hall OF ANY KIND UPON THE INSURER,ITS AGENTS O REPRESENTATIVES. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE 1 2L"'M ACORD 25(2001/08) ©ACORD CORPORATION 1988 of Xart4ai ptan z = �ASSAC1j1T8[tt4 " s � �., DEPARTMENT OF BUILDING INSPECTIONS / INSPECTOR 212 Main Street • Municipal Building Northampton,MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CNIR 108.3.4 to act as his/her construction sups: : sor. The state defines"Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location • � � �S�a37 RC})115rtt7 _- DEPART}.f ENT OF BUIL-DDJ G INSPECTIONS - 212 Main Street ' Municipal huddnig Northampton, Mass. 01060 WOMCER'S CON1TENSATTON I SURANCE A + + AV1T % ith a principal place of busiresslres denc.. t: 1 - -- --- dO hereby Certify, unelcr the p inns snd penalties of perjllr- :hal: am an emplOyei prOvlding the follov"Inc '•'dOi'_Ct`S coulDc lSal-lon GOVC:"2JC or Iny employces Working on tens job: (Lns.>rancc Coehpam') clic;Numtxr) ----- (rte pira ion Datc) ( j I am a sole pronrictor, ��_eneral c��u c e; ;�; hon-,eowoer (circle one) and hired the contractors listed belovr;,iho foil ::; '`.j Ar e �sor, -olc.es orn S cot, p n. ,NanC of Conti'actGr) (LnS^h1C LGInn;;ir,�G11Cr TJ 117 11 ?''::..IC' DfltC) (Name of COnn�:mor) -- (7iLslllmnce Com=a.il" Pohm Nlmb•r; (F>:r miion Date) (Name of Contractor) ;In��Jr��ic� Co nE; ;idol;c. Nusvtvr) =x;. ra,:oo mate) (Name of Con,,_j::tcr) — (I,1S1:micz, Co?11T�7__.:yP1 olio Numb_r) lF:;:n:-.:io- Dare) i ( 1 iUll a �;Olc pl OprtCtC)i Z'-Id havC t10 oil '•'�;r lii'i� fOi I ?i71 i? home OW!Ic- lt1"-, 11 :`, No,TF::pic-sc be aw: c L!a:.`•iIc t <r�o• r^ .�c:mil,y;.- , n::: �» aaatc cz:.r_.^ cs:c:.is ti +,+ >c;.city not u,cee th n tfv oo uai+s ir.t i c't he k:-ti ::ti.a rte: a cx;t .•_.._i z ut cr f i LhG�c c r t�crs111Y c ::::::: :o i` cz'•ployc3 u-�'cs ttr tvcri;n's c--._..rn,tr (GLt ?_-!(Sl ,-+:r ._, a t rnror`or_!M p Icgxl etatus of=QapIoyx under tvo We cle z,m anon!.cL I onde-Ttand dii!a copy of this etatc:s_'r_uy bo fO,n JrJ to tl»[Y_t n t xn of Ind"i rid Off—of for tix oova-agc vaifi=1ioc and that Edlusr to s_ co��r;un3: c�,iM 25A of MG1,152 ctn Icy to tIx pa eL:cs comisting oC a ftrx of up to S l SQU.LvJ a:J Y i^;,r, rti;.!of::p to or,:}- r.-.j civil peruttics in do t<Rn cf a S!r,,`•ti'c i;Ch a_rd tt Grp of S1Op.Do a d,y tgain:t mL F,dg;uunntsl use Pcrtnit NuutL:r Si-Inaturt: of _ - .iccac;eJf crmtttc':. _.__ ! t /r S CT�ON 8 CONSTRUCTIQNZERVICES 8 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone .e Not Applicable ❑ Company Name ° Registration Number Address Expiratlion Date Telephone SECTION 10 YVORKERS' COMPENSATION 11JSllRANCE,AFFIDAVIT(M.G.L-c. 152, § 250(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ 1 151121! The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famiies and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, on a form acecptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature ROPOSEDiWQRU, ch cle 7WaRan cab�le :..., ,'r,r=i,:.r.;�.. 5 i New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 2 Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ) Sidingg] Other( ] Brief Description of Proposed Work:/°"►�Y*,r+o��, P;t e -10 �fj A&�� /,�,v T �- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0• Sheet 0 a acl"tl.�t�;on `to�ezisfingosingcota' ; ee" tiellow,.n: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction i. Is construction within.100 ft. of wetlands? Yes No. Is construction within 100 yr. floodp)ain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . 1. Septic Tank City Sewer Private well City water Supply SECTd©Nl I N: TV BE COMPLETED YYNEN OWNf1EJ� CONTRACTOR gPPLJE$ FOR BUILDING PEf2M1T I 0A1 _ as Owner of the subject property hereby authorize J 0 ON 6 e r+5 to ac, on my behalf, in ters elat' t rk authorized by this building permit application. Signat a of er Date I, j�(/ r� as Owner/.Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Prinrtm�� Signature of Owner/Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES _ No IF-'YES, describe size, type and location: 'iq f of. Northampton rN � ; f1 ` i ding Department 12 Main Street Room 100 5EP - 4 2003 mpton, MA 01060 phone 41 -58 -1240 Fax 413-587-1272 SP iNn p,N ru- I 1 1 CT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION �Thts sectan orb' comp e#ed,by ff�ee� 1.1 Property Address: �, k y� Zone Over; D�str�n �> 1 :Elm St�Distfkt �� 8 D�Stnct SECTION 2- PRO:PERTYOWNERSHIP/AUTHORIZED AGENT. 2.1 Owner of Record: 1 name(Print) ur g ai4i ess: >-1 5� Telephone Signal re 2.2 4uthorized Ai ent: Name( nt) Current Mailing Address: Signature Telephone SEGTION..3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use=Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Eleclrical (b) 'E timated Total Cost.of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) f f I i 15. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check number This Section For Official Use,Only Building Permit-Number:, AA `-7-00 Date Issued: Signature: loo Building Commissioner/Inspector of Buildings, Date T- 61 CAHILLANE TEn k BP-2004-0248 GIs#: COMMONWEALTH OF MASSACHUSETTS r M lack:35- 187 CITY OF NORTHAMPTON Lot: -001 Pernut: Buiidinci Category: BUILDING PERMIT Permit# BP-2004-0248 Project# JS-2004-0364 Est, Cost:$5067.00 Fee: $250.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NELSON ROBERTS Lot Size(sq.ft.): 10018.80 Owner: APRILE MAXINE&DOUGLAS J Zoning: SR Applicant: APRILE MAXINE & DOUGLAS I AT: 61 CAHILLANE TERR Applicant Address: Phone: Insurance: 61 CAHILLANE TERR FLORENCEMA01062 ISSUED ON.914103 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE SIDING, REPLACE WITH NEW SIDING POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 9/4/03 0:00:00 1055 $250.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo